Aashray urology institute

Kidney Stones/Urinary Stones

Overview
Kidney stones or urinary stones are deposits of certain salts that form in the urinary system.
overview-kidney-stone.jpg
Image Source: National Institute of Diabetes
and Digestive and Kidney Diseases, National
Institutes of Health.
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What Are Kidney Stones/Urinary Stones?

The main function of the kidney is to remove extra water and wastes from the blood and convert it into the urine. However, sometimes, lack of fluid and excess of some salts can cause their deposits to build up and stick together in the kidney. These deposits begin as tiny crystals and may gradually grow into bigger particles. These are called kidney stones, also known as urinary stones, renal calculi, nephrolithiasis, or urolithiasis. The stones thus formed may stay in the kidney or move down into the urinary system (that is in the ureter, bladder, or urethra) thereby obstructing the flow of urine. Some stones can potentially damage the kidney by causing urinary obstruction, infection or even kidney failure. Hence they need to be treated in time, even though they are no longer causing pain.

At Aashray Urology Institute, the first NABH accredited standalone urology hospital in Gujarat; all the standard treatment options recommended worldwide are available as we understand that different types of urinary stones need different treatment options ideally. 

kidney-stones
urinary systems

What Are The Types Of Kidney Stones/Urinary Stones?

A stone’s size may vary from as small as the gravel of sand to as large as an egg. It may be smooth and round or rough with serrated edges. Based on their composition, the five major types of kidney stones are Calcium Oxalate, Calcium Phosphate, Struvite, Uric Acid and Cystine Stones.

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Image Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

What Are The Risk Factors For Kidney Stones/Urinary Stones?

Anyone can develop kidney stones; however, the following are the factors that increase the risk to develop them: 

  1. People living in hot, humid conditions and/or hard water areas
  2. People with a habitual low intake of fluids
  3. Family history of stones 
  4. Recurrent urinary infections
  5. Excessive intake of calcium, uric acid, certain medications or vitamin D
  6. Certain metabolic disorders, digestive disorders and medical conditions like renal tubular acidosis, cystinuria, hyperparathyroidism etc.

What Are The Symptoms Of Kidney Stones/Urinary Stones?

Dr. Ashit Shah, the chief urologist at Aashray Urology Institute, has listed down symptoms of kidney stones. They are as follow: 

  1. Severe pain in the back and side, in the area of kidney or in the lower abdomen
  2. Nausea, vomiting
  3. Pain or burning sensation during urination
  4. Bloody urine
  5. Fever and/or chills
  6. Frequent urge to pass urine

Not all patients with kidney stones have symptoms. Large stones do not cause pain as they are dormant in one place. Such stones may not be detected for a long time, maybe until the kidney is damaged. They could be incidentally detected during the investigation for some other ailment. Mobile small stones or granules (crystals) passing down the ureter do cause pain, however.

symptoms of kidney stones
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What Tests Are Required To Diagnose Stone Disease ?

If a person is suspected of having a urinary stone; after clinical examination, he/she will usually be asked to get a urine examination, blood test, plain X-ray and a sonography done. Occasionally a CT scan may be asked for. These tests suffice to diagnose stone disease in the majority of the cases.If the stone needs interventional treatment, then the patient will need to undergo a test called 'Intravenous Urography or C.T. Urogram' wherein a dye is injected into the patient’s vein and a series of X-rays or scans are taken to know the individual function of each kidney and the detailed anatomy of the urinary system.

x-ray for diagnosis of kidney

Do All Kidney Stones/Urinary Stones Require Treatment?

No, all urinary stones do not need interventional treatment. Small size stones pass naturally without damaging the urinary system. In more than 60% of cases, stones less than 6 mm size pass out on their own. These stones are prescribed conservative treatment.
The stones that need interventional treatment are the stones that are not likely to pass on their own, those with severe symptoms/significant obstruction/urine infection or those associated with abnormal urinary tract anatomy. However, it is important to consult a urologist and have a checkup to determine whether the interventional treatment is needed or not.

What Are The Treatment Options For Kidney Stones/Urinary Stones?

The options for kidney stones/urinary stones vary from conservative management to interventional management.

  1. Conservative Management

    Conservative or non-operative management is an expectant therapy wherein urologist feels that-

    1. The possibility of stone passing out naturally is high.
    2. That stone does not require any surgical intervention in the first place.
    3. The stone has less chance to cause damage to the kidney or the urinary tract even if it remains in place for long.
      In this treatment, the urologist ensures that the patient has adequate hydration and gives him medications to dissolve stones, treat infection, and prevent pain to facilitate the passage of stone smoothly. 
    Conservative management treatment option for kidney stone
    Conservative management


  2. Interventional Treatment

    The Interventional or operative line of treatment is chosen when -

    1. The stone is not likely to pass on its own on account of its size, shape or anatomic abnormality of the urine system.
    2. The stone is associated with significant symptoms, bilaterality etc. 

    Interventional treatment includes Non-invasive options like Shock Wave Lithotripsy, RIRS and Ureteroscopy; Minimally invasive options like PCNL and Invasive options like Open Stone Surgery.

1. Lithotripsy Treatment (E.S.W.L.)  

Shock wave lithotripsy, traditionally known as extracorporeal shock wave lithotripsy, is a non-invasive painless procedure that uses sound waves to fragment stones in the urinary system.

Procedure

  1. You will be given some medications to help you relax during the procedure. After that, you will be placed on the lithotripsy table and an anesthetic cream will be applied to the side of the body.  
  2. With the help of x-ray guidance, the doctor will then locate the stone and the lithotripter (the lithotripsy machine) will be put against the side of the body, close to the stone.
  3. Then a cushion filled with fluid will be raised under the table to rest under the kidney. 
  4. The doctor then will proceed to send shockwaves through the body which will blast the stones. You will hear the tapping sounds of stones breaking but won’t feel any pain.

Recovery 

  1. It’s a safe, non-invasive procedure requiring minimal anaesthesia. There won’t be any scar on the body and no blood loss.   
  2. As this is an outdoor procedure, you will be able to go home the same day and start the work from the next day itself. 
  3. Small pieces of stones (sand-like particles) are expected to pass out on their own over the next few days.
  4. You will be called for follow-up after 3 weeks for check x-ray.

This procedure is good only if it is selected for small, soft stones. In larger and hard stones, lithotripsy will require multiple stages or will not work and such stones may be best treated by endoscopic procedures like R.I.R.S. or P.C.N.L.

Lithotripsy-Treatment-(E.S.W.L.)1
Lithotripsy Treatment (E.S.W.L.)
Image Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

2. Ureteroscopy (U.R.S.)

Ureteroscopy or U.R.S. is an endoscopic procedure performed using a small telescope that is passed through the urethra and into the ureter to remove a stone. It is primarily meant for stones in the ureter.  

Procedure

  1. The procedure will begin after you are given anesthesia. After that, the doctor will insert a telescope-like instrument, called a ureteroscope, through the opening of your urinary tract and into the bladder without making any surgical cuts or incisions. 
  2. Then the doctor will examine the urinary tract (kidneys, ureters, and bladder) with the help of the scope and locate the stone.
  3. After locating the stone, it will be taken out intact with a basket-like device or broken into pieces with laser or pneumatic energy and then removed; depending upon stone size.
  4. If required, a stent may be placed in the ureter which is to be taken out after a prescribed time.
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Ureteroscopy (U.R.S.)
Image Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Recovery

  1. After this surgery is performed, you need to stay in the hospital for 1-2 days. 
  2. A check X-ray will be taken the next day to confirm 100% clearance of stone.
  3. After the discharge, one can resume the normal routine within a few days as these treatments have almost no convalescence period. 
  4. The advantage of this procedure is complete clearance of the stone in one go which proves to be cost-effective in the long run. It is a well-established and well-preferred treatment for ureteric stones worldwide.
  5. It is painless, has minimal morbidity, almost no mortality, and when done under fluoroscopy (x-ray guidance), these procedures give almost 100% results.

3. Retrograde IntraRenal Surgery (R.I.R.S.)

Retrograde IntraRenal Surgery (R.I.R.S.) is an endoscopic procedure wherein a small, flexible telescope is passed through the urethra and the ureter into the kidney to treat the stone(s) in the kidney. R.I.R.S. is the latest treatment option in the world for stones situated in the kidney. It has gained acceptance the world over and is expanding its indications very fast.

Procedure

  1. At the beginning of the procedure, you will be given general anesthesia. 
  2. After that, the scope will be placed through the urethra (the urinary opening) into the bladder and then through the ureter into the urine-collecting part of the kidney. The scope, thus, is moved retrograde (up the urinary tract system) to within the kidney (intrarenal).
  3. After getting a clear visual and access to the stone, it will be removed/ crushed into small fragments using laser or pneumatic energy.
  4. If required, a stent may be placed in the ureter which is to be taken out after a prescribed time.

Recovery

  1. After this surgery is performed, you need to stay in the hospital for 1-2 days. 
  2. The advantage of this procedure is that it avoids cut(s) on the kidney and body thereby being a much safer surgery. It gives very good results even on hard stones. There is no blood loss, minimal morbidity and almost zero mortality. It can be safely carried out in diabetics and other co-morbid conditions. It can even safely be performed in patients taking blood thinner medicines.
  3. After discharge, one can resume the normal routine from the next day as these treatments have almost no convalescence period. 
  4. Small pieces of stones (sand-like particles) are expected to pass out on their own over the next few days.
  5. You will be called for follow-up after 3 weeks for check x-ray.
ureteroscopy
Retrograde IntraRenal Surgery (R.I.R.S.)

4. Percutaneous Nephrolithotomy (P.C.N.L.)

When the stone in the kidney is too big/hard, P.C.N.L. is another surgical option. In this treatment, small instruments are put into the back through a small incision with the help of a telescope to suck or pluck the stones out. 

Procedure

  1. You will be given anaesthesia first followed by a prone position. 
  2. Then a puncture will be made into your kidney under sonography and X-ray guidance and a tract will be made. The tract will then be dilated to facilitate passage of the endoscope.
  3. After having direct access to the stone, the endoscope will be placed into the kidney and with the help of a mechanical instrument the stone will be crushed into small pieces and once they are small enough, they will be removed.
  4. If required, a stent may be placed in the ureter which is to be taken out after a prescribed time.

Recovery

  1. After this surgery is performed, you need to stay in the hospital for 4-7 days. 
  2. A check X-ray will be taken after 2 days to confirm 100% clearance of stone.
  3. After the discharge, one should avoid lifting heavy weight  or strenuous work for the  convalescence period of 4-6 weeks.

5. Laparoscopic Treatment

Laparoscopic method of stone removal is also an option; however, in a good endourology setup, almost any stone can be removed by the above mentioned procedures, thereby obviating the need for laparoscopic treatment. Laparoscopic treatment is not preferable over other minimally invasive treatment options as it requires general anaesthesia, multiple punctures on the body, longer operative time, considerable morbidity, and occasional mortality.

6. Open Stone Surgery

Open stone surgery is an outdated procedure. It is quite painful, carries the risk and morbidity of major surgery, a big scar, long hospital stay and a longer recovery period. It is problematic if the patient has to be re-operated in the future. 

Why Choose Aashray?

If you have been advised for stone surgery, you should check the following:

  1. Are you being offered the latest treatment options or are you offered open surgery with the excuse that “the stone is too big” or “multiple in number” ?
  2. What is the conversion rate of your urologist? In other words, in how many percent cases, does  he take the patient for non-invasive surgery, but ends up doing an invasive or open surgery (under various pretexts!).
  3. If your treating surgeon himself is going to operate or is somebody else going to come at his place and operate? In that case, will he be there to take your care in the post-operative period?
  4. Will this surgery be done in a urological setup by a  Urologist ?
  5. Does the Urologist have all the latest  treatment options like R.I.R.S. available with him or is he offering you a compromised  surgery option?
  6. Will the procedure be done under fluoroscopy (X-ray) guidance (as it should ideally be done)? Or is it done “Blindly” (i.e. without fluoroscopy)?
  7. Is your treating doctor adequately trained in doing these procedures?  What are his overall results? Will he be able to give you near 100% results, as is the international norm?
  8. Is the hospital equipped with the latest instruments? Does your Urologist have USG guided puncture in case of PCNL?
  9. Does your Urologist take a Check X-ray after the procedure to confirm that all stones are removed?

If the answer to any of these basic questions is adverse, you should rethink…..

We, At Aashray, Offer……..

  1. A dedicated centre for stone surgery offering  the world’s latest minimally invasive options.
  2. LUMENIS Laser Lithotripsy – World’s No.1 Surgical Lasers.
  3. World’s best intra-corporeal Pneumatic LITHOTRIPSY system (Swiss LITHOCLAST).
  4. ALLENGERS extra-corporeal LITHOTRIPSY system (for the first time in Gujarat).
  5. World class endoscopy instruments, incl. Digital  flexible ureteroscope.
  6. Dedicated urological with ultrasound (BK medicals) for  USG guided punctures during PCNL to reduce morbidity
  7. Not just the machines, but the man behind the machines is an expert too!
    Expert endo-urologist with conversion rate <0.001%.
  8. All endoscopic procedures done under fluoroscopic guidance as well as video monitoring.
  9. After all procedures, check X-rays are taken to confirm 100% stone clearance.

In other words, at AASHRAY, you are in expert and safe hands.

Book Appointment

If you have any questions or doubts about any Kidney/Urinary Stones treatment or any other treatment available at Aashray Urology Institute, book a consultation with Dr. Ashit Shah and he will expertly guide you on the same. 
Book Appointment
Dr. Ashit Shah

Dr. Ashit Shah

Meet the doctor

Dr. Ashit Shah

MB, MS, DNB(Urology), DLU(France)

Dr. Ashit Shah

Dr. Ashit Shah

Dr. Ashit Shah is a senior consultant Urologist heading Aashray Urology Institute. After completing his M.B.B.S. and M.S. in General Surgery, he was awarded Diplomate of National Board (D.N.B.) in Genito-Urinary Surgery by the National Board of Examinations, New Delhi. He earned his Diplomate in Laparoscopic Urology from Louis Pasteur University, Strasbourg, France in the year 2006. Dr. Shah has a special interest in Endo-Urology, especially Urolithiasis i.e. Urinary Stone Disease. Having spent more than 27 years in the profession of Urology, he has experience of over 75,000 urological consultations and more than 15,000 surgeries. Being counted amongst the torch bearers of ethical and transparent medical practice in the city of Vadodara, he was conferred ‘Inspiring Urologist Award’ for the year 2019 by The Economic Times.

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